Biologic Agents in Inflammatory Eye Disease

Non-infectious uveitis is a potentially sight threatening disease. Along the years, several therapeutic strategies have been proposed as a means to its treatment, including local and systemic steroids, immunosuppressives and more recently, biologic agents. The introduction of biologics can be defined as a new era: biologic therapies provide new options for patients with refractory and sight threatening inflammatory disorders. The availability of such novel treatment modalities has markedly improved the therapy of uveitis and considerably increased the possibility of long-term remissions. This article provides a review of current literature on biologic agents, such as tumor necrosis factor blockers, anti-interleukins and other related biologics, such as interferon alpha, for the treatment of uveitis. Several reports describe the efficacy of biologics in controlling a large number of refractory uveitides, suggesting a central role in managing ocular inflammatory diseases. However, there is still lack of randomized controlled trials to validate most of their applications. Biologics are promising drugs for the treatment of uveitis, showing a favorable safety and efficacy profile. On the other hand, lack of evidence from randomized controlled studies limits our understanding as to when commence treatment, which agent to choose, and how long to continue therapy. In addition, high cost and the potential for serious and unpredictable complications have very often limited their use in uveitis refractory to traditional immunosuppressive therapy

Cost-effectiveness of intravitreal therapy in Age-Related Macular Degeneration

Age-related macular degeneration (AMD) is still referred to as the leading cause of severe and irreversible visual loss world-wide. Advances in medical research have identified vascular endothelial growth factor (VEGF) as an important pathophysiological player in neovascular AMD and intraocular inhibition of VEGF as one of the most efficient therapies. Anti-VEGFs currently used to treat AMD included a monoclonal antibody (bevacizumab), an antibody fragments (ranibizumab), a fusion protein (aflibercept), and an aptamer (pegaptanib). The wide introduction of anti-VEGF therapy has led to an improvement in the prognosis of patients affected by AMD, with a consequent effects on the burden of care due to highly priced drugs, increasing patient numbers, and long-term disease chronicity. Aim of this review is to present an overview of available therapeutic strategies in AMD in term of clinical efficacy and economic sustainability

Follow-up a lungo termine nei pazienti con “dome-shaped macula” associata a distacco sieroso del neuroepitelio foveale trattati con la terapia fotodinamica

FOLLOW-UP A LUNGO TERMINE NEI PAZIENTI CON “DOME-SHAPED MACULA” ASSOCIATA A DISTACCO SIEROSO DEL NEUROEPITELIO FOVEALE TRATTATI CON LA TERAPIA FOTODINAMICA Ilir Arapi, MD Introduzione: Il distacco sieroso del neuroepitelio foveale (DSNF) nei pazienti con macula a conformazione cupoliforme (DSM) rappresenta la causa più frequente di riduzione dell’acuità visiva e invio presso le unità di cura oculistiche. Lo scopo di questo studio è quello di valutare i risultati a lungo termine del trattamento con la terapia fotodinamica (PDT) in una serie di pazienti miopi associati a DSM con DSNF. Materiali e Metodi: Lo studio è stato disegnato come serie retrospettiva interventistica. Sono state esaminate le cartelle cliniche di 18 pazienti consecutivi miopi (20 occhi) con DSM associata a DSNF e trattati con la PDT. I seguenti dati sono stati valutati: miglior acuità visiva corretta (BCVA), errore di rifrazione, le caratteristiche in fluorangiografia (FA) e angiografia al verde di indocianina (ICGA), la morfologia foveale tramite la tomografia a coerenza ottica (OCT) in modalità EDI. Un miglioramento o peggioramento della BCVA è stato definito come un aumento o diminuzione di 2 o più linee della BCVA, mentre gli occhi associati a risoluzione del fluido sotto la fovea dopo il trattamento sono stati considerati come rispondenti alla PDT. Risultati: Tutti gli occhi sono stati sottoposti a diversi trattamenti PDT con una mediana di 3 (1 °; 3 quartili 2; 3,75; intervallo: 1 - 7), mentre il follow-up mediano è stato di 22 mesi (1 °, 3 ° quartili 12; 40; intervallo: 4 - 55). Nell'ultimo follow-up 7 occhi (35%) hanno mostrato una completa risoluzione del DSNF e sono stati considerati rispondenti alla PDT. Nell’ultima visita del follow-up 5 occhi (25%) hanno mostrato un aumento della BCVA, 13 occhi (65%) hanno mantenuto una BCVA stabile, mentre 2 occhi (10%) hanno avuto una diminuzione della BCVA. L'analisi statistica ha mostrato che il miglioramento della BCVA era significativamente maggiore negli occhi rispondenti alla PDT (p = 0,027). L'area mediana di ipocianescenza maculare al baseline osservata durante i tempi tardivi dell’ICGA è risultata significativamente inferiore [2,6 mm² (1 °; 3 quartili 2.3, 2.8 mm², intervallo: 1,61-3,28)] nel gruppo di pazienti che hanno risposto alla PDT e hanno avuto un aumento di ≥2 linee Snellen della BCVA rispetto ai pazienti che sono stati considerati non rispondenti [8.1 mm² (1 °; 3 ° quartili 5.1; 10.2 mm²,intervallo: 4,50-14,26)] (p <0.001). Conclusioni: I nostri dati suggeriscono che gli occhi miopi affetti da DSM e associati a DSNF potrebbero reagire positivamente al trattamento PDT mostrando la risoluzione completa del distacco foveale e un aumento della BCVA se il quadro iniziale angiografico all’ICG presenta un’area limitata di ipocianescenza maculare.Introduction and objectives: Foveal serous retinal detachment (SRD) in patients with dome shaped macula (DSM) represents the most frequent reason of impaired vision and referral to eye care units. The aim of this study is to investigate the role of photodynamic therapy (PDT) as a therapeutic modality in myopic patients affected by DSM associated with foveal SRD. Methods: The study was designed as a retrospective interventional case series. The medical records of 18 consecutive myopic patients (20 eyes) with DSM associated with foveal SRD, and treated with PDT were retrospectively reviewed. Best corrected visual acuity (BCVA), refractive error, fluorescein angiography (FA), indocyanine green angiography (ICGA), and enhanced depth imaging (EDI) optical coherence tomography (OCT) findings were evaluated. Visual gain and loss were considered as increasing or decreasing of two or more lines of best corrected visual acuity (BCVA) respectively, and eyes with fluid resolution were considered as responsive to PDT. Results: All eyes underwent several PDT treatments with a median of 3 (1st;3rd quartiles 2; 3,75; range: 1 to 7) and with a median follow-up time of 22 months (1st;3rd quartiles 12; 40; range 4 to 55). At the last follow-up 7 eyes (35%) showed complete resolution of the foveal SRD being considered as responsive to PDT. At last follow-up visit 5 eyes (25%) showed an increased BCVA, 13 eyes (65%) maintained a stable BCVA, while 2 eyes (10%) had a decrease in their BCVA. Statistical analysis showed that BCVA improvement was significantly higher in eyes responding to PDT (p=0.027). The median baseline hypocyanescent macular area observed during late ICGA frames resulted significantly lower [2.6 mm² (1st;3rd quartiles 2.3; 2.8 mm²; range 1.61 – 3.28 mm²)] in the group of patients that responded to PDT and had an increase of ≥2 Snellen lines in BCVA versus the remaining ones that were considered non-responders [8.1 mm² (1°;3° quartili 5.1;10.2 mm²; range 4.50 - 14.26 mm²)] (p<0.001). Conclusions: Our data suggest that myopic eyes associated with DSM and foveal SRD might be responsive to PDT showing total resolution of fluid accumulation and positive BCVA changes, if baseline ICGA findings show evidence of a limited hypocyanescent macular area

Acute Retinal Pigment Epitheliitis

Acute retinal pigment epitheliitis (ARPE) is a benign, acute, self-limiting inflammation affecting selectively the retinal pigment epithelium (RPE) with reduced visual acuity, metamorphopsia and subtle changes at the level of the RPE

Measles

Measles is an acute, infective, highly contagious disease, caused by a virus belonging to the family of Paramyxoviridae, genus Morbillivirus

Idiopathic Retinal Vasculitis Aneurysms and Neuroretinitis (IRVAN) Syndrome

Idiopathic retinal vasculitis aneurysms and neuroretinitis (IRVAN) is the acronym used to describe a rare syndrome characterised by a peripheral retinal vascular occlusion secondary to a retinal vasculitis with multiple posterior retinal arterial aneurysms (Fig. 88.1). In 1995, Chang et al. [3] proposed “IRVAN”, describing ten cases with these features. This disorder is also known as “bilateral neuroretinopathy with multiple retinal arterial aneurysms”

Acute Zonal Occult Outer Retinopathy (AZOOR) Results from a Clinicopathological Mechanism Different from Choriocapillaritis Diseases: A Multimodal Imaging Analysis

Background and aim: AZOOR is a rare disease characterized by loss of zones of outer retinal function, first described by J Donald Gass in 1993. Symptoms include acute onset photopsias and subjective visual field losses. The syndrome is characterized by a normal fundus appearance, scotomas and electroretinographic changes pointing towards outer retinal dysfunction. Evolution, response to immunosuppressive treatment and outcome are difficult to predict. The aim of this small case series was to identify the morphological changes and sequence of events in AZOOR thanks to multimodal imaging. Methods: Charts of AZOOR patients seen in the Centre for Ophthalmic Specialized care (COS, Lausanne, Switzerland) were analyzed by multimodal imaging including fundus photography, fluorescein angiography (FA), indocyanine green angiography (ICGA), blue light fundus autofluorescence (BL-FAF) and spectral domain optical coherence tomography (SD-OCT) in addition to a complete ophthalmological examination including visual field testing and microperimetry, as well as OCT angiography (OCT-A) and ganglion-cell complex analysis when available. Cases and Results: Three AZOOR patients with a mean follow-up of 47 ± 25.5 months were included following the clinical definitions laid down by J Donald Gass. The primary damage was identified at the level of the photoreceptor outer segments with an intact choriocapillaris and retinal pigment epithelium (RPE) layer, these structures being only secondarily involved with progression of the disease. Conclusion: Although AZOOR has often been included within white dot syndromes, some of which are now known to be choriocapillaris diseases (choriocapillaritis entities), our findings clearly commend to differentiate AZOOR from entities such as MEWDS (Multiple evanescent white dot syndrome), APMPPE (Acute Posterior Multifocal Placoid Pigment Epitheliopathy), MFC (Multifocal Choroiditis) and others, as the damage to photoreceptors is primary in AZOOR (a retinopathy) and secondary in choriocapillaritis (a choriocapillaropathy)

Long-term control of non-infectious paediatric panuveitis refractory to traditional immunesuppressive therapy, successfully treated with Adalimumab (HumiraTM)

The aim of this paper is to present two cases of severe idiopathic non-infectious paediatric panuveitis, unresponsive to traditional therapy, successfully treated with Adalimumab (HumiraTM, Abbott Pharmaceutical Inc.) in the long term

Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a term introduced by Gass in 1968 to describe a syndrome of multiple plaque-like post-equatorial, circumscribed, flat, gray-whitish, subretinal lesions involving the retinal pigment epithelium associated with visual loss